Thursday, July 16, 2009

Week Three: Drug Runner

Hello again,

I have, over the last week or more, been slowly developing a slew of skills that make volunteering daily at the Subcentro de Salud a real job. But because there are three or fewer women running the health center at a time, what we do each day covers the entire medical spectrum. The following is a list of jobs I am now expected to do daily at the clinic.

Front desk: Includes taking patients’ information and locating their files, asking if they are at the clinic for ¨control o enfermedad¨ (vaccinations/birth control or sickness), and running patient histories from the patient intake room to the doctor´s office.

Computer Techy: I am also the official computer tech, and although I haven’t used Excel much, my technology skills far exceed those of Maria Ester. Together, we have revised and improved data on the computer, which often has duplicate patient names or ID numbers.

Patient Intake: After locating medical histories, I bring the patient (usually mother with her child) into a small room and record measurements, which includes blood pressure (for adults only), height, weight, temperature, and the circumference of the head (for children and babies only). These measurements, especially weight and temperature, are harder to take than they sound. I had to learn how to use two different old-fashioned scales, one for babies, the other for adults. The temperatures are taken with thermometers that have mercury in them, again the older version and not the digital kind I am familiar with. It brings to light what we might take for granted in the US with our updated medical technology.

When I am not doing one of these jobs, I am in the doctor´s office or the vaccination room where I continue to observe. The doctor, Viviane Bazante, examines a lot of babies and spends most of her time talking with parents about proper child care. A few days ago a set of twins came in. One was well over his proper weight, but the other was borderline malnourished. As the doctor was explaining this to the mother, she noticed that the mother was, in fact, nursing the healthy baby. The doctor immediately told her to switch, pointing out after how fiercely the smaller baby was nursing. Maria Ester is well-practiced in vaccinating children who react strongly, to needles and injections. She knows just how the mother needs to hold her child, and exactly how much time she has before the screaming begins.

Patient/Medic Relationships

One thing I have noticed over and over again is the importance of a good patient-medic relationship. Maria Ester knows practically everyone in Gualsaqui by name, and she can point out where they live and who their family members are. She talks with them about their lives and their troubles and listens to them carefully. Because of this, she has developed such a strong sense of trust with the village that they constantly ask for her and not the doctor. The doctora is the antithesis of Maria Ester. She is impatient, and speaks harshly to her patients in her office. She does not treat them as people, but rather a nuisance that gets in the way of her treatment and their sickness. As would be expected, her patients do not open up to her the way they do with Maria Ester, which is a huge disadvantage both to the patient and the doctor. Not only do patients not listen carefully to crucial instructions the doctor pelts at them, their glazed eyes and passive body language only frustrates the doctor more. Although it seems like common sense, juggling a patient´s feelings with treating their actual sickness is harder than it looks. Having seen both ends of the spectrum, it is clear to me that being a successful medical practitioner means caring not just about ¨solving¨ the sickness, but about who that person is as well, a skill Maria Ester has mastered in her last thirteen years as a practicing nurse.